Infliximab in the Treatment of Severe Psoriasis Vulgaris

Abstract

Psoriasis is a chronic, immune mediated inflammatory disease. The inflammatory activity of the psoriasis plaques is partially triggered by activation of the Th1 lymphocytes, which release pro-inflammatory chemokines and cytokines such as tumor necrosis factor alpha (TNF-α). Infliximab is a mouse-human chimeric monoclonal anti body that neutralize the biologic activity of TNF-α by binding to soluble and transmembrance forms of this cytokine and inhibiting it’s binding to the receptors. We aim to assess the efficacy and tolerability of infliximab in severe psoriasis vulgaris. Materials and Methods: Twenty patients were included in the study, 12 men and 8 women with severe psoriasis vulgaris, were assigned infliximab infusion 5 mg/kg at weeks 0, 2 and 6, followed by maintenance therapy every 8 weeks. For every patient psoriasis activities and treatment efficacy were assessed by measuring Psoriasis Area Severity Index (PASI) scores Results: Among the 20 patients enrolled in this study, 2 patients are dropped out from the study after first dose due to hypotension or mild urticarial reactions. Eighteen patients had completed the course of treatment for 32 weeks. Maximum PASI score at baseline was 64 and minimum PASI score was 14 (Mean PASI score was 32.88 ±10.871). PASI score was greatly reduced from 32.8 to 16.2 in 6 weeks and to 2.2 in 10 weeks time. 50% improvement at the after the 1st dose (2 weeks) in 8 patients (45.5). In 10 patients (54.5%), 75% improvement in PASI score from baseline at tenth week. About 90% improvement in PASI score in most of our patients (16) at sixteenth week and all patients had complete clearance at twenty 24th week and 32 weeks of treatment. The acute adverse effect was infusion reactions were reported in one patient during the initial 1ST week, and hypotension which occurred at week 2 this lead to discontinuation of the drug. Infections manifested as delayed adverse effects where 2 of 18 patients (11.1%) developed UTI at week 2nd and week 16th also another patient at week 6 developed URTI & UTI from week 0. All reported infections were mild and treated during the course. In conclusion, infliximab was found to be safe and effective and well tolerated in the treatment of recalcitrant plaque psoriasis. To the best of our knowledge this is the first study to be published in Libya and North Africa.